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To assess the previous periapical status and the quality of root canal filling as predictors of the outcome in initial non-surgical endodontic procedures. A retrospective cohort study was designed in which the presence of a previous periapical lesion was determined radiographically. The quality of the root filling was evaluated in terms of homogene...
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Context 1
... subjects provided 244 teeth for a total of 349 roots with initial non-surgical EP. Some patients contributed with more than one tooth (Table 1) and a 13.18% failure rate was determined. Regarding the follow-up period for the included teeth, the univariate analysis established an average of 5.3 ± 4.29 years, also determined that most of the roots did not show apical lesion and adequate quality of root canal filling (Table 2). ...Similar publications
To evaluate the shaping efficiency of WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland) and One Curve (OC; Micro-Mega, Besancon, France) in J-shaped resin blocks. Forty simulated J-shaped root canals with 0.15 mm apical diameters and 2 % taper were divided into two groups (n=20) as follows; WOGG/WOG (25.07) group (glide path was created...
Introduction: The aim of this study was to evaluate the cyclic fatigue resistance of three heat-Treated nickel-Titanium (NiTi) systems at simulated body temperature. Materials and Methods: Twelve instruments of similar apical diameter (#25) from three engine-driven NiTi instruments; WaveOne Gold (WOG), Hyflex EDM (HEDM), and M Pro system were teste...
The aim of this study was to analyze and compare the influence of the geometrical cross-section design on the dynamic cyclic fatigue resistance of NiTi endodontic rotary files.
Materials and methods:
Forty sterile endodontic rotary files were selected and distributed into the following study groups: A: 25.06 double S-shaped cross-section NiTi all...
Success in endodontic therapy is achieved after thorough cleaning and shaping of root canal system followed by its complete ob-turation. However, owing to anatomic perplexities. this therapy at times may be more complicated than expected. The morphological variations of the Mandibular first molar demand careful clinical approach to avoid failures....
Citations
... Typically, MSMs have three roots: one located on the palate side, one on the mesiobuccal side, and another on the distobuccal side, with usually one canal in each root [2]. Failing to locate and properly treat all root canals is one of the main reasons for unsuccessful root canal procedures [3]. Nevertheless, the internal anatomy of these teeth can be unpredictable. ...
... Nevertheless, the internal anatomy of these teeth can be unpredictable. Often, incomplete cleaning or filling of undetected canals is a key factor behind treatment failure [3]. Missed canals tend to occur because of their complex shapes, limited exploration, or the constraints of traditional two-dimensional (2D) X-rays. ...
This case report presents a less common anatomical variation in a maxillary second molar (MSM)
characterized by four roots - two buccal and two palatal - and four distinct canals. The report emphasizes the
significance of advanced diagnostic imaging and careful clinical evaluation in identifying and managing less
common anatomical variations in maxillary second molars. Specifically, it presents the endodontic
management of an MSM with two buccal and two separate palatal roots - detected using a cone beam
computed tomography (CBCT) - underscoring the importance of comprehensive canal mapping and precise
diagnosis in achieving treatment success. A 40-year-old male patient presented with intense pain in the
upper right second molar, as reported by his general dentist. Clinical examination showed moderate pain on
percussion and palpation. The radiological examination by CBCT scan revealed four separate roots and canals (two buccal and two palatal), with three canals filled with calcium hydroxide (Ca(OH)₂). Non-surgical
root canal treatment was approached for the endodontic treatment. The nine-month follow-up showed resolution of all symptoms without pain on percussion and palpation. We conclude that a comprehensive understanding of the complex root canal morphology of MSMs is crucial for achieving successful endodontic
outcomes. While common variations include three roots and three canals, less frequent configurations, such
as a single root or four distinct roots with separate canals, emphasize the importance of comprehensive assessment. The prognosis currently demonstrates a higher success rate due to advancements in endodontic instruments and materials. Several factors play a role in success rate, such as the operator's experience, the
number and location of canals, the treatment duration, and the utilization of tools like a microscope and
CBCT, which can enhance the chances of achieving higher success rates in managing unusual variations of MSM.
... Numerous studies have demonstrated a substantial correlation between poor root filling quality and ETT failure [30][31][32]. Correspondingly, our findings suggested that an insufficiently obturated root (underfilled) with no discernible void was a strong predictor of success. Even though this finding was consistent with earlier research [33][34][35], some authors reported contradictory evidence [32,35]. ...
... Correspondingly, our findings suggested that an insufficiently obturated root (underfilled) with no discernible void was a strong predictor of success. Even though this finding was consistent with earlier research [33][34][35], some authors reported contradictory evidence [32,35]. García-Guerrero et al. found that short length filling was a significant predictor for failure, even when an optimal grade of tapering and homogeneity were present [32]. ...
... Even though this finding was consistent with earlier research [33][34][35], some authors reported contradictory evidence [32,35]. García-Guerrero et al. found that short length filling was a significant predictor for failure, even when an optimal grade of tapering and homogeneity were present [32]. ...
Introduction
Endodontic therapy has been regarded as a safe treatment option with highly promising results in preserving natural teeth. Numerous factors may influence the longevity of endodontically treated teeth (ETT), thus altering their success/survival rate. This study aimed to determine the survival and success rates of endodontically treated premolars and molars with different complex restorative/prosthodontic treatments.
Materials and Methods
A total of 190 patients with an ETT were included, who had received final coronal restoration up to 14 days after the temporary one and at least one year prior to the enrollment. The investigator evaluated the quality of endodontic filling, coronal restoration, mobility, and proximal contacts. Data were analyzed with multiple binary logistic regression and the Chi-Square test.
Results
The average duration of follow-up was 28.6±11.9 months. Overall, 89.4% (170/190) of the teeth survived. The overall success rate for the investigated teeth was 70.5% (134/190). Success rates of 100% for crown, 95.7% for post and core crown (PCC), and 94.7% for amalgam build-up with post were achieved. However, the success rates were 75%, 52.5%, and 50% for amalgam build-up, composite build-up, and PCC with crown lengthening, respectively. The Chi-square test revealed that there was a significant difference between the different restorations in terms of success (P<0.001). Multiple binary logistic regression models revealed that coronal leakage (P=0.048), obturation void (P=0.037), obturation length (P=0.020), mobility (P=0.002), type of the restoration (P<0.001), and proximal contact (P<0.001) were significant predictors for success. However, apical lucency, root length, marginal caries, tooth type, and post did not appear to be significant indicators of success (P>0.05).
Conclusions
ETT with minimal mobility, exhibiting underfilled obturations without visible voids, and having received crown/PCC/amalgam build-up with a post, along with the presence of both proximal contacts, tend to exhibit a significantly high success rate.
... Also, in this study, the root canal fillings that are shorter than 2 mm from the radiographic apex were significantly associated with AP more than root canal fillings that end 0-2 mm from the radiographic apex by approximately 2 times (98% risk) as shown in Table 3. These findings incorporate findings from other studies that found a higher chance of detecting AP in teeth with root canal filling ends more than 2 mm from the radiographic apex (26,27). On the other hand, root filled teeth with root filling ending beyond the apex have no risk of radiographic detection of AP, probably because of the elimination of the microorganisms from, and complete obturation of, the root canal system. ...
Objective:
This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images.
Methods:
Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chi-square and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05.
Results:
AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respectively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively.
Conclusion:
The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images. (EEJ-2024-02-042).
... Cleaning, preparing, and ensuring a hermetic seal of the root canal system are widely recognized as essential steps for achieving successful endodontic treatment 1,2 . ...
Aims: This study aimed to assess the quality of various filling techniques in ovoid root canals prepared using M® instruments. Materials and Methods: Sixty ovoid root canals underwent endodontic treatment with M® instruments and were subsequently divided randomly into four experimental groups, each employing a different obturation technique: TU - single cone; TL - active lateral condensation; TH - Tagger hybrid; TS - Schilder technique. Digital radiographs were taken in both mesiodistal and buccolingual directions to examine the filled teeth. The percentage of filling material and empty spaces was quantified using Photoshop® software. Data were subjected to statistical analysis using the one-way ANOVA test and T test (? = 0.05). Results: In the TL and TS groups, there was a significantly lower average percentage of unfilled spaces compared to the TU and TH groups (P<0.0001). When analyzing the radiographic directions, the mesiodistal view exhibited the highest mean percentage of unfilled spaces, with differences in filling quality observed only in the TU and TL groups. Conclusions: Active lateral condensation and Schilder techniques demonstrated superior performance in achieving effective filling of ovoid root canals.
... In case of failed root canal treatment, the retreatment procedure is a conservative way to preserve the affected tooth. In clinical studies, nonsurgical primary endodontic treatments have resulted in several success rates between 73.5% and 92.3% (20). Nonsurgical retreatment enables healing of periapical tissue and long-term survival of the tooth (21). ...
Objective
The removal of the root canal sealer is an important factor in nonsurgical retreatment. The aim of this study was to compare the removal of AH Plus, Well Root ST, and AH Plus Bioceramic Sealer using Protaper Universal retreatment files.
Methods
The curved mesio-buccal canals of extracted mandibular molars were prepared with the Protaper Gold file system (up to F2). Specimens were randomly divided into 3 groups and filled with the single cone technique using AH Plus, Well-Root ST, and AH Plus Bioceramic Sealer, respectively. After two weeks, the root canal filling of all specimens was removed using Protaper Universal retreatment files. All specimens were scanned using micro-CT. The remaining volume of the root canal filling was recorded in total and the coronal, middle, and apical third of each specimen.
Results
Well-Root ST and AH Plus Bioceramic Sealer groups had a higher percentage of total remaining filling material than the AH Plus group (P<0.05).
Conclusion
This study has shown that the volume of remaining root canal filling was significantly higher in the samples filled with calcium silicate-based sealers.
... Zhong et al, 43 Santos et al, Song et al have demonstrated an association between the quality of root canal filling and outcome of non-surgical endodontically treated teeth. [44][45][46] Initially, no. of roots was used as a unit of measurement for assessment of treatment outcome and has tendency to overestimate success rate. Since, the aim of this study is the comparison of prognostic value of laser assisted RCT and conventional RCT without any confounding factor, the number of roots were excluded. ...
Aims: The aim of this study is to conduct a comparative analysis of prognostic value of laser-assisted root canal treatment (LART) and conventional root canal treatment (RCT).
Material and Methods: A retrospective analysis of 50 cases equally divided between Laser-assisted root canal treatment (LART) and conventional RCT, was done using Clinician-reported Outcome (ClinRo) protocol by modifying Chugal et al scoring criteria.
Results: Statistical analysis using Mann-Whitney U tests revealed no significant correlation between gender and total treatment quality score. However, significant correlation was found between treatment modalities, and with laser assisted RCT treatment it showed a superior correlation and better prognostic results.
Discussion: The radiographic analysis focused on periapical lesions and root canal filling quality. Laser-assisted RCT demonstrated a higher proportion of complete healing cases for periapical lesions and improved root canal filling quality compared to conventional RCT.
Conclusion: The study supports the potential benefit of laser assisted RCT in non-surgical endodontic interventions. Laser-assisted RCT showed better prognosis in terms of periapical healing and root canal filling quality when compared to conventional RCT. The study encourages further research and clinical validation to establish laser assisted RCT as a viable option in endodontic therapy.
... In most cases, endodontic failure is caused by remaining microorganisms inside the RCS (including the dentinal tubules), which can even reach up to half the distance between the root canal walls and the cementum-dentin junction (9). Considering that excessive intraradicular wear compromises the longevity of the endodontically treated teeth, eliminating or decreasing the number of microorganisms located deep inside the dentinal tubules is only feasible by promoting their direct contact with chemical substances (irrigation) (4), intracanal medication (22) and filling materials (23), or indirectly from the dentin alkalinization provided by the use of calcium hy-e891 Fig. 4: Analysis of the interaction between independent variables (concentration. irrigation method, and root canal third) on the depth of intratubular penetration of NaOCl. ...
... droxide as intracanal dressing (22). Both antimicrobial processes are complemented by the nutritional scarcity obtained after conducting the root canal filling and definitive restoration (23). Several methodologies have been used to assess the depth of intratubular penetration of NaOCl (17,24,25). ...
Background
The permanence of microorganisms in the root canal system represents the main cause of endodontic failure. Considering the impossibility of effective action of the endodontic files in ramifications of the main canal and mainly inside the dentinal tubules, a better understanding of the irrigation dynamics to enhance endodontic prognosis is essential. Objective: To evaluate the depth of intratubular penetration values of sodium hypochlorite (NaOCl) (dependent variable) by comparing different concentrations, methods of irrigation, and root canal thirds (independent variables) and to investigate the existence of interactions among them, capable of influencing the dependent variable.
Material and Methods
40 roots from extracted human maxillary central incisors were stained and instrumented according to four irrigation protocols (n. 10): conventional irrigation (CI) at each use or change of instrument, and final irrigation with 5ml of 2.5% or 5.25% NaOCl, with or without passive ultrasonic irrigation (PUI), respectivelly. Measurements based on stereomicroscopic images were obtained, and the data were subjected to statistical analysis (p< 0.05).
Results
The highest depth values of intratubular penetration of NaOCl were observed in the cervical third, at 5.25%, and by PUI. When only two independent variables were analyzed in association, the highest penetration depth values of NaOCl were obtained at 5.25%, regardless of irrigation method, at 5,25%, in the cervical third, and; in the cervical third, despite of irrigation method. Considering the three independent variables simultaneously, the highest depth values of intratubular penetration of NaOCl were observed in the cervical third, at 5.25%, no matter the irrigation method. The interaction between the independent variables on the penetration depth values of NaOCl was only confirmed considering the irrigation method and root canal third.
Conclusions
Intratubular penetration of NaOCl was influenced by the three independent variables individually and when the irrigation method and root canal third were considered simultaneously.
Key words:Dentinal tubules, Depth, Disinfection, Irrigation, Root canal system, Sodium hypochlorite.
... One of the most important factors contributing to failure of root canal treatment is incomplete instrumentation or obturation of missed root canals. 4 Maxillary molars present one of the most complicated root canal anatomies. 1,2 The presence of three roots with three individual canals (mesio-buccal, disto-buccal, and palatal) is the most common appearance in maxillary second molars (MSMs), followed by the presence of three roots with four canals. ...
... The success of root canal treatment in cases with unexpected root canal morphology requires proper diagnosis, careful inspection of clinical radiographs, use of magnification, and most importantly thorough knowledge of the dental anatomy and its various modifications. 2,4 Despite the wide range of variations in the reported root and canal morphology of MSM teeth, the presence of two palatal canals is considered a rare occurrence. MSMs most commonly have one palatal root with a single canal. ...
Cases of unusual and complex root canal morphology could be difficult to diagnose and treat. This report describes the diagnosis and management of a rare maxillary right second molar (tooth #17) with two distinct palatal canals. The tooth was diagnosed with irreversible pulpitis and symptomatic apical periodontitis. Non-surgical root canal treatment was performed. Accurate diagnosis and comprehensive treatment of cases with unusual root canal morphology can be achieved by evaluation of periapical radiographs at different angulations, advanced magnification techniques, and the Cone Beam Computed Tomography (CBCT) scanning. Clinicians should be aware that two separate palatal canals could exist in maxillary second molar teeth.
... The sample size was calculated based on a preliminary study in which the exposure factor of short obturation length estimated a 20% failure rate versus a 6.8% failure rate for teeth having flush obturation [18]. Therefore, with a confidence level of 95% and a power of 80%, a sample size of 243 teeth was estimated to be distributed in a ratio of 4:1 (teeth without the exposure factor:teeth that present it) [19]. ...
Introduction
The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association.
Methods
A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronal restoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results.
Results
A total of 232 teeth in 155 participants were analysed. A χ2 value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome.
Conclusions
The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied.
... This study was reported in accordance with the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines 22 . The sample size was calculated a priori using the Epi Info 7.2 software (Centers for Disease Control and Prevention, Atlanta, GA) with a 95% confidence level and 5% alpha; this calculation was based on previous studies with a similar outcome 23,24 , which led to a minimum of 196 teeth for the findings to be statistically significant. From a pool of 4201 patients treated at the graduate endodontic clinic from January 2015 to December 2020, a total of 474 patients who were diagnosed with AAP were included in this study. ...
Introduction:
This retrospective cohort study aimed to estimate the success rate (SR) of primary root canal treatment on teeth with a diagnosis of pulp necrosis (PN) and asymptomatic apical periodontitis (AAP) when using 2% chlorhexidine gel as an auxiliary chemical substance (ACS) and foraminal enlargement instrumentation technique.
Methods:
This study evaluated 178 patients with 206 teeth submitted to primary root canal treatment performed by graduate residents in endodontics. The inclusion criteria were patients who underwent treatment over a period of 1 to 7 years on teeth with a diagnosis of PN and AAP. The SR was evaluated clinically and radiographically and categorized considering strict' (complete resolution of periradicular lesion) or 'loose' (reduction in the size of existing periradicular lesion) criteria. Cases of clinical and/or radiographical absence of repair were classified as a failure. Two calibrated examiners independently assessed treatment outcomes using the ImageJ software.
Results:
The SR were 81.1% (95% CI: 75.7% - 86.4%) and 87.4% (95% CI: 82.8% - 91.9%) when considering the 'strict' or 'loose' criteria, respectively. Females had a higher SR when strict criteria were applied. Also, the SR was significantly reduced when there was an increase in the patient's age.
Conclusion:
Within the limitations of this study, it was found that teeth with a diagnosis of PN and AAP and treated associating the use of 2% chlorhexidine gel and foraminal enlargement achieved substantial SR. Gender and age were prognostic factors that played a significant role in the SR. Future randomized controlled trials should further investigate the effects of foraminal enlargement and 2% chlorhexidine gel as an ACS.
